Recovery From Long COVID — Colchester Physiotherapy

We still understand very little about long COVID, symptoms vary significantly from person to person but fatigue appears to be a common issue.

We don’t know why some people are affected by it whilst others aren’t. We don’t know what causes the symptoms or how long they last. At the moment we seem to have many more questions than answers. One thing that sadly we do know is that rehabilitating people from long COVID is a challenge, but some key areas to focus on are emerging:

Breathing
Pacing
Sleep

BREATHING

We need to get the basics right first
If we can breathe then we have an energy source to help with everything else

We all assume that we know how to breathe, but sometimes our breathing patterns can become muddled particularly after illnesses and stressful events. This makes COVID the perfect antagonist to our breathing patterns. Not only does it affect our lung, COVID is both physically and emotionally stressful so it has real potential to alter our breathing patterns.

But our breathing patterns are just that, patterns. We can change them. This is a technique that I will often use in clinic with people:

Lie on your back with you head on a comfortable pillow and your knees bent.
Place one hand on your chest and one hand on your stomach.
As you breathe in and out see if you can direct your breath in to different areas using your hands for feedback as to where you are breathing.
As you breathe out try not to force the air out, instead think about relaxing the area that you have breathed in to to allow the air to come out.
It is this relaxing to breathe out that is the most important part of the exercise.

I don’t tend to worry too much about whether people are breathing in to their chest or their stomach as long as they can breathe in to each area. Being relaxed in your breathing is where I tend to focus.

PACING

Perhaps the most important component of recovery from long COVID is pacing.

The goal of pacing is to manage our energy. The key principle here is to take a break before you feel you need to. The aim of pacing is to stop before we drain the battery, if we push our luck too much with COVID there is a really high chance of a setback.

An activity diary can be really useful to help with pacing:

Record all your day to day activities, everything from sitting to doing a crossword, cooking to going for a walk all the way through to higher level activities like exercise.
Assign each activity a score based on how easy you find each activity. I tend to use just three criteria here: 🙂😐🙁.
This helps you to identify the activities that you are struggling with the most. The activities that score 🙁 are the ones that you need to pace. The aim is to establish a sustainable baseline. To do this you should look to reduce the activities that score a 🙁 in intensity, frequency or duration so that they become 😐 or 🙂.
Your aim is to establish a baseline were you only have scores of 😐 and 🙂. It sounds simple in theory, in practice it is never this straightforward and takes a fair amount of trial and error to get the hang of this.
Don’t worry if you still if you have done the above and have activities that score 🙁, rehab is never a straight line, it’s always a bendy road! Just be aware that these are your most limiting activities, these are the ones that you have to be careful with.
The aim now it to build up in (very) small steps over time, don’t try and build the activities that score 🙁 you are already struggling with these, these are the activities that you need to pace. Also don’t focus on the activities that score 🙂, you can already do these. It is the activities that score 😐 that you should look to build up.

So to summarise what you do with each activity:

🙁 - pace yourself/give yourself plenty of time to recover
😐 - build up (in small steps)
🙂 - enjoy!

Our goal is to keep gradually building and building, but we always need to remember with COVID rehab that if we push our luck too much there is a really high chance of a setback.

One thing that we have found with long COVID rehab is that we have to pace physically, cognitively and emotionally. Each of these areas tend to affect the others. So if you have an emotionally difficult day then you probably won’t be able to do as much physically. If you go for a long walk then you may not be able to do a crossword. If you read a book in the afternoon then you may not be able to do the cooking in the evening.

This is where your activity diary can be really helpful, it can help identify patterns unique to you.

SLEEP

Sleep is an important part of the body’s natural healing process. If we can improve both the quantity and quality of our sleep then we maximise our chances of recovery from COVID.

These simple strategies can be effective at improving both the quantity and quality of our sleep:

Get outside, daylight (particularly morning light) helps with melatonin production
Avoid caffeine late in the day. Caffeine can significantly reduces the quality of our sleep and stays in our system for 6-8 hours. So if you go to bed at 10pm, try to avoid having any caffeine after 2pm.
Try to sleep and wake at regular times.
Avoid alcohol in the evenings.
Take time to relax before you go to bed - try reading a (paper) book, taking a bath or shower. This is also a good time to work on your relaxed breathing (see above).

Whilst COVID can be difficult to recover from, it is worth remembering that the human body is highly adaptable and able to recover from the most severe events, injuries and illnesses. Often all we need to do it give it the opportunity and the time to heal.